Right atrial lymphoma in combination with kidney cancer: а case report

Introduction. Primary cardiac lymphomas are a rare pathology that presents certain diagnostic difficulties. In addition to chemotherapy, an important aspect of such patients is arrhythmias and conduction disorders. Indications for pacemaker implantation and timing of the intervention in such situations continue to be discussed. Brief description. A case of right atrial (RA) B-cell lymphoma in an elderly female patient is presented. The patient had previously been examined for bradycardia and presyncope. Third-degree atrioventricular (AV) block and complete left bundle branch block were detected, followed by a dual-chamber pacemaker implantation. Apparently, conduction disorders were caused by tumor growth in the AV node area. However, paraclinical signs could not be identified at that time. Three weeks later, the patient was hospitalized due to hypotension and coma. The specific electrocardiographic performance (signs of right, not left bundle branch block in right ventricular pacing) required assessment for lead displacement and cardiac perforation. Echocardiography revealed para-aortic hyperechoic cavities with heterogeneous contents, linear shadows in the aortic valve cusp coaptation area, interpreted as aortic root abscess or aortic aneurysm, and manifestations of infective endocarditis. The RA tumor was diagnosed only at autopsy. The second finding was clear cell renal cell carcinoma, which had also not been previously detected by echocardiographic examination. Discussion. A case of a rare combination of two tumors demonstrates the difficulties in diagnosing cardiac lesions and emphasizes the importance of their early recognition even when manifested by non-specific symptoms.